吻合血管股前外侧筋膜瓣的临床应用

目的探讨吻合血管股前外侧筋膜瓣修复前臂及手部创面的临床应用。方法2000年9月-2003年12月收治前臂及手部软组织缺损13例,男8例,女5例;年龄19-43岁。机器碾压伤3例,皮带绞伤4例,重物压伤6例。软组织缺损部位前臂掌侧6例,手背部6例,食指桡、背侧1例。缺损范围17.5cm×7.7cm-4.6cm×3.4cm,其中4例合并前臂、手部骨折,9例合并前臂、手部伸肌腱损伤。患者均急诊行清创、骨折复位内固定,修复损伤的神经、肌腱及血管,术后抗感染治疗3-5d后,采用吻合血管的股前外侧筋膜瓣联合中厚皮片植皮修复软组织缺损。结果术后患者均无血管危象发生。1例第4、5指蹼处约2.0cm×1.0cm植皮坏死,经换药及再次取全厚皮植皮后成活,余患者筋膜瓣及植皮均成活。全部获3-12个月随访,修复后的创面外形均良好,无皮肤挛缩。按中华医学会手外科学会上肢部分功能评定标准优9例,良2例,可1例,差1例,优良率85%。结论吻合血管股前外侧筋膜瓣联合植皮修复前臂及手部创面外形好,不需再次手术整形,远期无皮肤瘢痕挛缩发生,供区处理简单,创伤小。

CLINICAL APPLICATION OF VASULARISIED ANTEROLATERAL THIGH FASCIAL FLAP

OBJECTIVE: To evaluate a modified anterolateral thigh fascial flap designed for the treatment of the soft tissue defects in the forearms and hands. METHODS: From September 2000 to December 2003, a modified anterolateral thigh fascial flap combined with the intermediate split thickness skin graft was applied to the treatment of 13 patients with the soft tissue defects in the forearms or the hands. There were 8 males and 5 females, aged 19-43 years (average, 27. 6 years). Three patients had a mangled injury, 4 had a belt injury, and 6 had a crush injury; 6 patients had their tissue defects on the palm side of the forearm, 6 had their tissue defects on the dorsal side of the hand, and 1 had the defect in the index finger (dorsal side of the hand). The tissue defects ranged in size from 17. 5 cm x 7. 7 cm to 4. 6 cm x 3. 4 cm. In addition, 4 of the patients had an accompanying fracture in the forearm or the hand, and the remaining 9 had an extenor tendon injury. All the patients underwent emergency debridement and reposition with an internal fixation for the fracture; 3-5 days after the repair of the injured nerves, muscle tendons and blood vessels, the tissue defects were repaired with the anterolateral thigh fascial flap combined with the intermediate split thickness skin graft. RESULTS: No vascular crisis developed after operation. All the flaps survived except one flap that developed a parial skin necrosis (2.0 cm x 1.0 cm) in the hand, but the skin survived after another skingrafting. The follow-up for 3-12 months revealed that all the flaps and skin grafts had a good appearance with no contracture of the skin. According to the evaluation criteria for the upper limbs recommended by the Hand Society of Chinese Medical Association, 9 patients had an excellent result, 2 had a good result, I had a fair result, and 1 had a poor result, with a good/excellence rate of 85%. CONCLUSION: The modified anterolateral thigh fascial flap combined with the skin graft is one of the best methods for the treatment of the soft tissue defects in the forearms and the hands. This method has advantages of no requirement for a further flap reconstruction, no skin scar or contracture in the future, easy management for the donor site, and less wound formation.